What Exactly Does A Health Insurance Navigator Do?

Health Insurance Navigators assist people in enrolling for health coverage through the health insurance marketplaces of ACA or the Affordable Care Act. They also assist people if various issues that crop up after signing up. The details of the Navigator position are available in Section 1311(i). It was in 2013 when the exchanges first started, and navigators started assisting the consumers. Below is every detail you need to know about exactly what the function of a health insurance navigator is. Besides that, you will also learn about their training, payments, and where you can find a navigator.

What Assistance Can You Get from Health Insurance Navigators?

People who need to sign up for health insurance coverage can receive various kinds of assistance from navigators. Before you enroll, they will help you determine whether you have eligibility for CHIP, Medicaid, or subsidies. You would also receive education and outreach concerning the available healthcare coverage.

Navigators can be helpful, especially for people who are signing up. You can also get assistance from them regarding your enrollment and any other issue in the post-enrollment period. The responsibilities of a navigator have evolved over the years.

In 2018, the HHS or Department of Health and Human Services asked the navigators for targeted assistance to the vulnerable individuals. Besides that, they also had to provide post-enrollment assistance. This includes services like helping consumers with claim denials, eligibility, pre-authorization denials, premium payments, etc. Additionally, they also help applicants understand how to use health coverage and subsidy reconciliation. When the Department of Health and Human Sciences updated the rules for the year 2020, the additional duties were made optional for the Navigators. Navigators could provide more services, but there was no hard and fast rule.

Training of the Navigators

The exchanges or the marketplaces train and certify the navigators. Exchanges run by the states have different standards for Navigator training and certification. In the case of states that use HealthCare.gov, the federal government handles the training and certification.

Federal requirements suggest that navigators need to take up 5 to 20 hours of training a year. Besides that, Navigators also need to undergo training to stay up-to-date with the issues and solutions. Navigators also receive recertification programs from the federal government annually.

Where Can You Find a Navigator?

You can find a Navigator at a clinic, a local hospital, or a nonprofit organization. However, if you are actively looking for assistance from a Navigator, you can go through your state’s exchange website and search how to get enrollment assistance. There is a find local help section on the federal website.

You can check out the enrollment assistants in your locality. In addition to that, you can also check out the Navigator Grant Recipients Links if you are looking for Navigator organizations in the state you reside in. Since the Navigator organizations can change every year, make sure that you check the most recent link. If you are thinking of enrolling for health coverage in 2022, you can access more Navigator organizations.

How Are the Navigators Paid?

The health insurance exchange funds the navigator organizations. Health insurance brokers receive compensation from health insurance companies. That’s not the case with navigators.

In most states, it’s the federal government that runs the exchange. The exchange provides grants to Navigator organizations operating in those states. With regards to states that run their exchanges, these exchanges fund the Navigator organizations.

Funding from the federal government fluctuates with time. For funding next year, the Navigator funds are provided in the late summer of the previous year. The Navigator funding from the federal government for 2016 and 2017 have amounted to $63 million per year. However, the funding for 2018 came down to $36 million. For the years 2019, 2020, and 2021 plan years, the funding dropped to $10 million.

Conclusion

Healthcare Navigators receive all the training and certifications necessary to help citizens with their health insurance process. At times like now, when health insurance is crucial, everyone needs to avail of the services of the Navigators to get health coverage for 2022. As these services are free, you can ensure you have the right insurance cover without burning a hole in your pocket. Your local governing bodies and health care institutions will have all the details you need about your local navigators to make your enrollment process a seamless one!